Emergency Room Cover

Modified on Thu, 12 May 2022 at 08:51 AM

This benefit covers an emergency at any registered emergency/hospital casualty facility when you require immediate medical treatment due to an accident/trauma; illness or child emergency illness.*
*applicable to Ultimate Gap


This benefit covers an emergency at any registered emergency/hospital casualty facility when you require immediate medical treatment due to an accident; illness or child emergency illness.**
**applicable to Plus Gap


This benefit covers an emergency at any registered emergency/hospital casualty facility when you require immediate medical treatment due to an accident and illness.***
**applicable to Gap Assist | Gap Lite

 

Options

Ultimate Gap | Plus Gap | Gap Assist | Gap Lite | Corporate Comprehensive | Corporate Base

  Gap Only | Exact Cover | Exact with Gap and Copay


Description:

This benefit covers an emergency at any registered emergency, hospital, or casualty facility when you require immediate medical treatment due to an accident and trauma, or illness. 


Accident / Trauma Benefit; Illness Benefit and Child Emergency Illness Benefit is covered as a stated benefit on the Ultimate Gap options. For these options, a medical aid statement is not a requirement.


Accident Benefit; Illness Benefit and Child Emergency Illness Benefit is covered as a stated benefit on the Plus Gap Cover options. For these options, a medical aid statement is not a requirement.


Accident Benefit is covered as a stated benefit on the Gap Assist and Gap Lite options.  For these options, a medical aid statement is not a requirement.


Illness Benefit covers the gap portion only on the Gap Assist and Gap Lite options.  For these options, a medical aid statement is a requirement.


Important points to consider:

  • Only covers for treatment between 18:00pm and 7:00am weekdays excluding weekends and public holidays. *Applicable to Illness Benefit and Child Emergency Illness Benefit only*
  • Illness benefit, applicable to any beneficiary 9 years and older.
  • Child emergency illness benefit, applicable to children 8 years and under.   
  • Ambulance costs are not covered by this benefit.
  • We will cover a GP’s emergency facility where no hospital emergency is available within a 30km radius within the above stated benefit limits.
  • ICD-10 Diagnosis codes are used to validate claims against this benefit, please ensure that your provider uses the correct ICD-10 and treatment codes

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